According to the World Health Organization (WHO), oral diseases affect people throughout their lifetime and may give rise to pain, discomfort, disfigurement, and even death. According to their estimations, it affects nearly 3,7 billion people worldwide. Examples of oral diseases include tooth decay (or dental caries), gum (or periodontal) disease, total tooth loss (edentulism), oral cancer, and oro-dental trauma.1 Oral diseases may require dental treatments, and some common dental procedures include tooth extraction, root canal treatment, wisdom tooth removal, dental implants, and periodontal surgery.2,3 Let us look at some of these procedures in more depth.
Tooth extraction
Tooth extractions are done to remove decayed or damaged teeth.3 While often done without any problems, tooth extractions may be complicated by bleeding, pain, swelling, or delayed healing.4
Wisdom tooth removal
Wisdom teeth usually come through in one’s late teens or early twenties and sit at the back of the gums. Most people have 4 wisdom teeth: one on each of the upper and one lower gums on both sides of the mouth. When wisdom teeth emerge at an angle or only emerge partially due to an obstruction, they are called impacted. Impacted wisdom teeth that do not cause any problems usually do not have to be removed,2 but when impacted wisdom teeth cause problems such as pain or infection, they are usually surgically removed.2,3
Root canal treatment
Root canal treatment is also called endodontics. It is done to treat an infection at the centre of a tooth or the root canal system. When the blood or nerve supply of the tooth has become infected, the infection will spread if left untreated. Root canal treatment is performed to try and salvage the tooth. During the procedure, the infective material is removed from inside the root canal system following which the canal is filled, and the tooth is sealed with a filling or crown to prevent it becoming infected again.2
Dental implants
Dental implants are alternatives to dentures and are done to replace missing teeth.2,3 They can be inserted to replace just a single tooth or several teeth. The procedure involves the placement of titanium screws that are drilled into the jawbone to support a crown, bridge or denture.2
Gum grafts
Gum grafts treat thinning or receding gums.3
Dental bone grafts
Dental bone grafts are done to increase the volume and density of the jawbone.3
How to prepare for oral surgery or dental procedures
Minor procedures performed in a dentist’s rooms may not require much preparation. However, if the procedure requires sedation, it may be best to:3
- Arrange for a family member, friend, or colleague to drive you to and from the facility where the procedure is done.
- Abstain from eating or drinking for several hours prior to the procedure, depending on the instructions that you have received from your dentist or doctor.
- Take a couple of days’ sick leave as recommended by your dentist or doctor.
Complications of dental surgical procedures
As with any surgical procedure, oral surgery or dental procedures also carry the risk of complications. These include, but are not limited to:3,4
- Infection
- Injury to neighbouring teeth
- Dry socket (see below)
- Numbness
- Tooth fragments left behind
- Sinus perforation (puncturing of the sinus membrane)
- Bleeding
- Postoperative pain
- Swelling.
A dry socket is also known as alveolar osteitis, and it is the most common local complication after surgical removal of a tooth. It is defined as postoperative pain (at the site where the tooth was extracted) increasing in severity at any time between 1 and 3 days after extraction accompanied by a totally or partially disintegrated blood clot within the alveolar socket, with or without halitosis (bad breath). The pain is severe, persistent and throbbing in nature and is felt in and around the extraction socket. It can radiate to different adjacent areas and usually develops 2 to 3 days after tooth extraction. It may last for several days to weeks and often does not respond adequately to pain killers. The exact cause is not known.4
The risk of complications can be reduced by:
- Using a moist gauze to place over the socket following a tooth extraction. This will help to prevent subsequent bleeding. The gauze should be moistened to prevent the blood from coagulating in the gauze and then pulling the blood clot off when the gauze is removed.Talking should be kept to a minimum for 3 to 4 hours.4
- Avoiding spitting and vigorous swishing as this can wash away blood clots or interfere with healing.3,4
- Avoiding use of a straw after a tooth extraction as sucking on a straw will create a negative pressure that can displace a blood clot but also contribute to the development of a dry socket (see above).4
- Waiting at least 48 hours before exercising as one is more prone to bleeding when your blood pressure and heart rate go up.3,4
- Not cleansing the mouth for the first 24 hours after an extraction to prevent bleeding. Following this, the mouth and teeth may be cleaned with a soft brush, and a 0,2 % chlorhexidine mouthwash can be used to irrigate the mouth after every meal.4
- Elevating your head to minimise swelling.3
- Eating soft foods like yoghurt, soup, pasta, mashed potatoes, pudding, eggs and rice.3
- Taking all medications as prescribed.3
- Using heat and cold therapy.3 Intermittent cold compressions are advised for the first 24 hours after an extraction to prevent swelling. Warm saline mouthwashes can be initiated 24 hours after the procedure and warm saline gargles may help to prevent infection and to promote healing if done 48 hours after the procedure.4
Recovering from dental procedures
Although healing times may vary from person to person, most people will feel like themselves after approximately two to three days. The more extensive the procedure, the longer it will take to recover. Although one may feel better, recovery will continue for some time. Soft tissues (like gums or cheeks) usually health in about a month, but bone could take up to 6 months to heal.3
Pain after dental surgical procedures (e.g., 3rd molar extraction, implant placement, periodontal, and endodontic surgery) is usually most intense approximately 5 to 6 hours after the procedure. It will be at its worst during the first postoperative day. Dental surgeons frequently use local anaesthetics just before or during a procedure to numb the area and to provide adequate pain relief. Bupivacaine, a local anaesthetic, may also be used to perform a nerve block that can provide pain relief for a period of up to 12 hours. Nonsteroidal anti-inflammatory medicines are considered the most effective options for the management of dental pain after the surgery has been completed.5 These medicines, which include molecules like ibuprofen, diclofenac, and naproxen, have been shown to be more effective than opioid pain relievers when it comes to dental postoperative pain.5,6 However, they should be avoided in patients with bleeding disorders or those taking blood thinners.6 Nonsteroidal anti-inflammatory medicines and opioid medicines (such as codeine or tramadol) are sometimes combined when pain is not adequately relieved with administration of a single agent.5
Today, non-steroidal anti-inflammatory medicines can also be given as a mouthwash or throat spray. This is especially useful for patients who cannot take these medicines orally, as it has been shown that after use as a throat spray or mouthwash, diclofenac concentrates in the cells lining the mouth before being gradually absorbed. After absorption, blood concentrations are very low and insufficient to cause systemic effects.7,8 In addition, it has been shown that diclofenac mouthwash was as effective as oral diclofenac in terms of relieving postoperative pain following periodontal surgery.9
A widely accepted pain management principle developed by the WHO advocates “around-the-clock” dosing rather than taking medicine when pain is experienced. In other words, patients are advised to take their pain medication at regular intervals (for example, every 3 to 4 hours) rather than wait until they feel pain before taking their pain killers.10
When to see a doctor
If you experience any of the following signs or symptoms after a surgical dental procedure, it may indicate that you have developed an infection and you should visit your doctor without delay:3
- Severe pain that does not respond to pain medication
- Fever of 38,9 °C or higher
- Pus coming from your incisions.
References
- World Health Organization. Oral health. World Health Organization [Internet] 17 Mar 2025; available from https://www.who.int/news-room/fact-sheets/detail/oral-health
- National Health Service. Dental treatments. National Health Service [Internet] 18 Jul 2022; available from https://www.nhs.uk/live-well/healthy-teeth-and-gums/dental-treatments/
- Cleveland Clinic. Oral surgery. Cleveland Clinic [Internet]; 01 Oct 2024; available from https://my.clevelandclinic.org/health/procedures/oral-surgery
- Goswami, A., et al. A general overview of post extraction complications – prevention, management and importance of post extraction advices. Fortune Journal of Health Sciences 3(3), 135-147 (2020).
- Malamed, S.F. Pain management following dental trauma and surgical procedures. Dental Traumatology 39, 295-303 (2023).
- Becker, D.E. Pain management: Part 1: Managing acute and postoperative dental pain. Anesthesia Progress 57, 67-79 (2010).
- SAHPRA-approved Professional Information for ORALACT 0,74 mg/ml Mouthwash; dated 18 May 2022
- SAHPRA-approved Professional Information for ORALACT 1,48 mg/ml Throat Spray; dated 18 May 2022
- Mishra, A.et al. Effect of diclofenac mouthwash on postoperative pain after periodontal surgery. Journal of Clinical and Diagnostic Research 11(4), ZC24-ZC26 (2017).
- Anekar, A.et al. WHO analgesic ladder. NCBI Bookshelf – StatPearls [Internet] 23 Apr 2023; available from https://www.ncbi.nlm.nih.gov/books/NBK554435/?report=printable
